| Objective:1.we analyzed the clinical efficacy of endoscopic sinus surgery for nasal cavity and paranasal sinuses in recent 10 years retrospectively,and discussed the influencing factors of the overall survival and the effect of comprehensive treatment,then we summarized the treatment experience.2.Analysis the two group's curative effect of EER and EAR.To explore the importance of minimally invasive surgery to select cases strictly,we summarized the personalized and precise treatment strategy driven by histopathology,T staging and primary site.Method:We chose the endoscopic cases and full follow-up patients,retrospective analysis of the clinical data of 57 cases of 2007.01-2016.10 who diagnosed with sinonasal malignant tumors and initially treated in our hospital of Otolaryngology Head and neck surgery,18 cases of stage T2(31%),26 cases of T3(46%),13 cases of T4(23%).6 cases of stage N1(11%),no case with distant metastasis.We grouped them according to the method of operation: 28 cases(49%)of EER group,29 cases(51%)of EAR group.The local control rate of 2,3,and 5 years was observed after the operation,the survival rate of distant metastasis and the overall survival rate were observed.SPSS22.0 statistical analysis software was used to process propensity score matching,Kaplan-Meier method was used to calculate the survival time,Longrank test and Cox model regression analysis.Result:1.Follow-up time of EAR group is 129 months,the median follow-up time is 60 months,local recurrence in 12(37.93%)cases,distant metastasis in 4 cases(13.79%),12 cases of death(41.38%),the 3 year local control rate was 75.86%,distant metastasis free survival and overall survival rate are 93.10% and 72.41%,5 year local control rate is 62.07%,distant metastasis free survival is 86.21%,the overall survival rate of 60.62%,in which phase III + IV for 3 years and 5 years survival rates are 62.07%,51.72%;followup time of EER group is 97 months,the median follow-up time is 24 months,local recurrence in 5 cases(17.86%),distant metastasis in 2 cases(7.14%),6 cases(21.42%)of death,the 2 year local control rate is 85.71%,distant metastasis free survival and overall survival rate are 92.86% and 78.57%,which 2 year survival rates in stage III and IV are 71.43% and 66.67%.2.The total survival of the two groups before matching was not significant(P=0.4472).After matching,the overall survival of the group EAR was better than that of the EER group(P=0.0369).The overall survival before and after the matching is related to the surgery margin that showed(P<0.001)before matching and(P=0.005)after matching.3.The T staging of group EER had statistical significance for total survival(P=0.030),the total survival of the patients received comprehensive treatment was statistically significant(P=0.020).Conclusion:1.Endoscopic endonasal surgery is safe and effective in the application of SNM.2.The negative margin and T staging are the influencing factors for surgical treatment of sinonasal malignancies.3.The application of nasal endoscopy via nasal approach needs to select suitable cases,not to pursue minimally invasive surgery.Patients with contraindication of endoscopic sinus surgery should be assisted by nasal endoscope.MDT and personalized precise treatment is necessary.4.We advocate that we should adopt a combination therapy based on histopathology combined with tumor T staging and site of lesions to develop personalized,precise and comprehensive multimodal combination,5.Local recurrence is the main reason for the failure of the treatment,so we should emphasize the importance of local comprehensive treatment. |
PDF Full Text Request